Is Belgium restoring the death sentence?

Media from across the globe are reporting on the planned euthanasia death of long-term Belgian prison inmate, Frank Van Den Bleeken. 

Van Den Bleeken applied for euthanasia originally in 2010. He has been in prison for thirty years and is serving a life sentence for sexual crimes including rape. The Dutch news service, Volksrant says that Van Den Bleeken was determined to be criminally insane by the Belgian Courts after being tried for numerous rapes, one including murder. He is reported as saying that he is a 'menace to society' and, on those grounds has refused any consideration for parole. Yet he also says that the conditions in his internment are 'inhumane'. Volksrant clarifies Van Den Bleeken's intolerable situation:

"Due to lack of space in the psychiatric institutions more than 1,100 forensic psychiatric patients just sit in jail, where they hardly get therapy.Thirty years Van den Bleeken is in a cell, without any hope of change."I'm sitting here in a sort of sarcophagus, to wait until I die," he said in a documentary."

That Belgium has a very poor record in how it treats prison inmates is widely known as acknowledged by head of the Belgium Euthanasia Evaluation Commission, Dr Wim Distelmans and others. Distelmans predicted that this case would, therefore, evoke international criticism: 'Belgium already has a bad reputation when it comes to the care of internees. That, combined with a high-profile topic like euthanasia, is not (to) be ignored' he told De Morgen press.

Distelmans was involved in the original assessment of Van Den Bleeken in 2010, but did not go ahead with the euthanasia request at that time, 'Because I found that not all therapeutic options, which includes palliative care, were checked.'

This is a curious statement. On the one hand, Van Den Bleeken is not dying; his 'suffering' is claimed to be 'unbearable psychological anguish', not a terminal illness where palliation would provide a possible benefit. On the other hand Distelmans himself has been involved in a number of other high profile cases where it was clear that other 'therapeutic options' were available. Consider the case of the Verbessem twins, Nathan Verhelst or Tom Mortier's mother.

Yet, on the 15th of September a Court of Appeal in Brussels gave Van Den Bleeken permission for a 48 hour hospital stay where he would be killed by euthanasia. This is expected to take place within the next few days. Giving this permission, the judge confirmed that Van Den Bleeken had, 'exhausted all possibilities to ease his suffering.' This comment is, at best, a white-wash.

Even Dr Distelmans seems to be uncomfortable with this decision. The De Morgengen headline has Distelmans questioning whether Van Den Bleeken is a 'Victim of illness or policy?'

As I said earlier, and as Distelmans confirms, Belgium has a poor track record in its treatment of prisoners; a fact that has not escaped the ire and criticism of the European Court of Human Rights from time to time. But it is nevertheless a matter of Belgian policy as to exactly what freedoms and rights are denied a prisoner by virtue of his or her incarceration. In Australia in recent years the question of whether prisoners have the right to vote is one such example. That Van Den Bleeken needed to resort to a court action to access euthanasia makes that point as is the news, as reported in De Standard, that 15 inmates have since also requested euthanasia.

Media and social media comments abound. 'Belgium restores the death sentence', 'Life term commuted to death', 'Belgian murder brings back the death penalty' are just a few. The harsh reality that Van Den Bleeken clearly sees euthanasia as a way out of his incarceration and attendant difficulties will escape no one.

One commentator questioned whether "A request for euthanasia of an internee should be allowed as an extension of a failing system?" De Morgen's editorial comments went on to observe that, without treatment, it could not be known whether Van Den Bleeken's suffering was caused by 'the disease or the context'; a clear reference to the fact that he had received only one, short-lived, treatment and had been denied access to a Dutch treatment option by the Belgian courts.

Since his court application, Van Den Bleeken has been offered a future place at a psychiatric institution. He has refused, preferring, instead, to stick to the path towards his own death.

The De Morgen article above also quotes an otherwise unidentified Thistle Mans' indignation:

"Imagine the same situation in a cancer patient: Suppose that is terminally ill and suffering, but that a sensible and reasonable treatment option is possible in a neighboring country that if you would euthanize, then everyone would be scandalized."

While this is quite a reasonable observation, it ignores the reality that euthanasia requests are routinely granted for people who have not undergone or have refused to undergo reasonable and available treatment options. As Dutch Professor Theo Boer observes 'Euthanasia is on the way to become a 'default' mode of dying for cancer patients'. That Van Den Bleeken had sought treatment and was refused is the crux of the matter in this case.

Van Den Bleeken clearly saw that he had 'no choice'; that reasonable options were denied him. Even in a country like Australia real choice in terms of palliative care options is not uniformly available to everyone. Even the choice to refuse treatment is, therefore, not available to all.

Any lack of real choice in medical care is a lack of imagination and provision in public health policy that demands attention. Refusal of good care options, when available, is indeed a matter for the individual; but neither situation places a burden of responsibility on legislators to provide for euthanasia lest, at some future time, like Belgium, we stand accused of an injustice.